Hello and welcome to The Anthropocene Reviewed, a podcast where we review different facets of the human-centered planet on a five-star scale. I’m John Green, and today I’ll be reviewing two forms of ingesting poisons. On the one hand, we have chemotherapy, a medical intervention to treat cancer. On the other hand, we have a hot-dog eating contest.

Let’s begin at the corner of Surf and Stilwell Avenues in Brooklyn’s Coney Island, home to Nathan’s Famous, a restaurant that started out in 1916 as a hot dog stand run by Polish immigrants Nathan and Ida Handwerker. The hot dogs were made from Ida’s recipe, and if they tasted like a contemporary Nathan’s Famous Hot Dog, they were … fine? A Nathan’s Famous Hot Dog is not the best food you will ever eat, or even the best hot dog you will ever eat. But there’s something special about the experience of eating one, the brackish smell of the Atlantic Ocean in your nose, the fading din of the once-great Coney Island in your ears. And the hot dogs do have a pedigree—they’ve been eaten by King George VI and Franklin Delano Roosevelt. Stalin even supposedly ate one at the Yalta Conference in 1945.

Coney Island used to be the huckster capital of the world, where fast-talking barkers wearing straw hats would sell you on this carnival attraction or that one. Now, like all places that survive on nostalgia, it’s mostly a memory of itself. The beaches are still packed in summertime; there is still a line at Nathan’s Famous; and you can still ride the carousel—but they’re not selling fun anymore. They’re selling reminiscence.

Except. One day a year, Coney Island becomes its old self, for better and for worse. Every year, on the U.S.’s Independence Day of July 4th, tens of thousands of people flood the streets to witness a spectacular exercise in metaphorical resonance known as the Nathan’s Famous Hot Dog Eating Contest. Like, the most widely observed annual celebrations of American independence are 1. Fireworks displays, which are essentially imitation battles complete with rockets and bombs, and 2. A contest in which people from all over the world attempt to discover how many hot dogs and buns can be ingested by a human within ten minutes. To quote the great Yakov Smirnoff: What a country.

Like the nation it aims to celebrate, the hot dog eating contest has always been a strange amalgamation of history and imagination. The contest’s originator was probably a guy named Mortimer Matz, who has been described as “part P. T. Barnum, part political scalawag.” Matz made much of his money as a PR rep for politicians in crisis--a resource never in short supply in New York--but he also did public relations for Nathan’s Famous. He claimed that the hot dog eating contest could trace its history back to July 4th, 1916, when four immigrants staged a hot dog eating contest to determine which of them loved America the most. But in reality, the contest started in the summer of 1967, when several people were given an hour to eat as many hot dogs and buns as they could. A 32-year-old truck driver named Walter Paul won the initial contest with a purported 127 hot dogs and buns in a single hour, although bear in mind that number was fed to the press by Mortimer Matz.

The event didn’t really become annual until the late 1970s. Most years, the winner would eat ten or eleven hot dogs in ten minutes. Despite the best efforts of Mortimer Matz, the hot dog eating contest was a fairly quiet affair until 1991, when a young man named George Shea became competitive eating’s professional hype man.

Shea was an English major who loved Flannery O’Connor and William Faulkner and wanted to become a novelist, but instead he is the last great American carnival barker. He wears a straw hat and has become known for his annual introductions of the contest’s competitors. In fact, Shea’s annual pre-show performance often lasts longer than the hot dog eating contest itself. He always starts out with reasonably normal introductions. “In his rookie year, he is already ranked #24 in the world,” Shea began one year. “From Nigeria, now residing in Morrow, Georgia, he’s eaten 34 ears of sweet corn. Six feet nine inches tall, let’s hear it for Gideon Oji.” But as we meet eater after eater, the introductions become progressively more surreal. Introducing 72-year-old Rich LeFevre, Shea said, “When we are young, we drink our coffee with milk and sugar. And as we age, we drink it with milk only, then we drink it black, then we drink it decaf, then we die. Our next eater is at decaf.”

They get weirder. Of another eater we are told, “He stands before us like Hercules himself, albeit a large bald Hercules at an eating contest.” Introducing longtime competitive eater Crazy Legs Conti, who is a professional window washer and the French-cut green bean eating champion of the world, Shea tells us, “He was first seen standing at the edge of the shore between the ancient marks of the high and low tide, a place that is neither land nor sea. But as the blue light of morning filtered through the darkness it revealed the man who has been to the beyond and witnessed the secrets of life and death. He was buried alive under sixty cubic feet of popcorn and he ate his way out to survival.” If you don’t regularly watch ESPN, it’s maybe difficult to understand just how weird this is compared to their daily fare, which is almost entirely comprised of either athletic events or former athletes pontificating about current athletes. ESPN is not in the business of visiting the place that is neither land nor sea.

But ESPN is a sports network, and I guess that competitive eating is a sport. Like any sport, this one is about seeing what a human body can accomplish, and like any sport it has a variety of rules. You have to eat the hot dog and the bun for it to count, and you’re immediately disqualified if during the competition you experience a so-called “Reversal of Fortune,” the sport’s euphemism for vomiting. The competition itself is, of course, gruesome. These days, the winner usually consumes over 70 hot dogs and buns in ten minutes.

One can feel something like joyful wonder at the magnificence of a Megan Rapinoe cross, or the elegance of a Lebron James fadeaway. But it’s hard to construct the Nathan’s Famous Hot Dog Eating contest as beautiful. When a soccer ball is at Lionel Messi’s feet, you don’t want to look away. When watching competitive hot dog eating, you can’t bring yourself to look away. The hot dog eating contest is a monument to overindulgence, the Anthropocenic belief that more is always better.

But I think it’s also about something else. The world’s best competitive eater, the American Joey Chestnut, has said of Shea’s introductions, “He convinces the audience these guys are athletes. He does such a good job, he convinces me I’m an athlete.” The carnival barker is an obvious flimflam artist—we know Shea is kidding when he refers to Joey Chestnut as “America itself,” and claims that the first words his mother ever told him were, “You are of my flesh but you are not mine own. Fate is your father and you belong to the people, for you shall lead the army of the free.” We know that’s a joke. And yet people scream along. They chant, “Jo-ey Jo-ey Jo-ey.” As the announcer continues to rile the crowd, they began to chant: U-S-A. U-S-A. The energy in the crowd changes. We know that Shea is kidding. And yet…his words have power.

Beginning in 2001, a Japanese man named Takeru Kobayashi won the hot dog eating contest for six consecutive years. Kobayashi totally revolutionized the approach to the competition—before him, no one had ever eaten more than twenty-five hot dogs in twelve minutes. Kobayashi ate 50 in 2001, more than double what the third-place eater that year managed. His strategies—including breaking each dog in half and dipping the bun in warm water—are now ubiquitous at the contest. Kobayashi was long beloved as the greatest eater of all time, although he now no longer participates in the contest because he refuses to sign an exclusive contract with Shea’s company. But he did participate in 2007, and when the Japanese Kobayashi was beaten by the American Chestnut, Shea shouted into the microphone, “We have our confidence back! The dark days of the past six years are behind us!” And that seemed to give the crowd permission to fall into bigotry. You can hear people shout at Kobayashi as he walks over to congratulate Chestnut. They tell him to go home. They call him Kamikaze and Shanghai Boy. Recalling this in a documentary over a decade later, Kobayashi wept as he said, “They used to cheer for me.”

When you have the microphone, what you say matters, even when you’re just kidding. Maybe especially when you’re just kidding. It’s so easy to take refuge in the “just” of just kidding. It’s just a joke. We’re just doing it for the memes. But the preposterous and absurd can still shape our understanding of ourselves and each other. And ridiculous cruelty is still cruel.

I love humans. We really would eat our way out of sixty cubic feet of popcorn to survive. And I’m grateful to anyone who helps us to see the grotesque absurdity of our situation. But the Carnival Barkers of the world must know their power, and they must be careful which preposterous stories they tell us, for we will believe them.

I give the Nathan’s Famous Hot Dog Eating contest three stars.

After the break, we’ll turn our attention to chemotherapy. But first….

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A funny thing about chemotherapy, and maybe the only funny thing about chemotherapy, is that the word itself means “chemical therapy.” So if you’re a literalist, it’s chemotherapy to treat seasonal allergies with Claritin or an ear infection with penicillin. But for our purposes we are concerned with “chemotherapy” as it is usually defined, as a cancer treatment. While surgical cancer treatments date back over a thousand years and radiation therapy was first used in 1896, effective oncological chemotherapy did not emerge until 1942.

No one who is familiar with chemotherapy will be surprised to learn that its development was linked to chemical warfare. There’s a famous World War I poem in which the poet Wilfred Owen writes of a victim of a chemical attack, that the young man’s “blood / come gargling from the froth-corrupted lungs / obscene as cancer.” Owen, by the way, went on to die in combat one week before the Armistice was signed. His mother received the telegram informing her of her son’s death as the church bells were ringing out to celebrate the war’s end.

That line, “obscene as cancer”, has always stuck with me. In Illness as Metaphor, Susan Sontag writes that many people in the 1970s weren’t told that they had cancer because it was seen as too devastating a diagnosis. “Cancer patients,” she writes, “are lied to, not just because the disease is (or is thought to be) a death sentence, but because it is felt to be obscene—in the original meaning of the word: ill-omened, abominable, repugnant to the senses.”

The obscene gas Owen describes was probably chlorine, but it may have been sulfur mustard, commonly known as mustard gas, which when deployed can remain spread out across the ground for weeks, and which causes horrifying burns on the skin and inside the lungs. Autopsies of mustard gas victims found that their white blood cell counts were lower and that the gas seemed to slow hemopoiesis, the production of blood cells. A pair of researchers at Yale, Louis Goodman and Alfred Gilman, were hired by the U.S. Department of Defense to determine whether there might be therapeutic uses for the chemical weapon. They created a related but more stable compound called nitrogen mustard, and first tested it on a human with lymphoma in 1942. The patient’s tumors shrank dramatically, and although the benefits were short-lived, they were profound. A 1946 article in the New York Times proclaimed, “While the nitrogen mustards do not cure any form of cancer, they do prolong life in many instances.”

Meanwhile, in the late 1930s, the English hematologist Lucy Wills, working in India, found that poor women were more likely to experience life-threatening anemia caused by a deficiency of what came to be known as “the Wills Factor,” which today we know to be folic acid. The pediatric cancer researcher Sidney Farber noted that when folic acid was given to children with leukemia, it seemed to make their cancer worse—the out-of-control replication of cells got even faster. And so Farber reasoned that antifolates might slow cancer growth—and, indeed, children with leukemia began experiencing remissions when taking antifolate drugs, although again the remissions were initially brief.

The novelist Peter de Vries’s 10-year-old daughter Emily experienced a months-long remission from leukemia after chemotherapy, but the cancer returned and she died a few days before her eleventh birthday. In the wrenching novel he wrote the next year, The Blood of the Lamb, de Vries referred to “the false face of mercy.”

Among the early pioneers of chemotherapy was Jane Wright, a doctor in New York who was the first to treat solid tumors—including breast cancer—with the antifolate now known as methotrexate. Dr. Wright was the granddaughter of Ceah Wright, a black man born into slavery who after emancipation went to medical school and became a physician. Dr. Jane Wright pioneered a wide array of cancer research and treatment innovations, including the use of a catheter system to deliver chemotherapy drugs directly to organs like the kidneys, using human tissue cultures to test potential drugs, and using combination therapies of multiple drugs to treat cancer. Methotrexate remains a commonly prescribed chemotherapy drug to treat breast and lung cancers, among others, and it was also the first drug to cure metastatic cancer.

Over the next several decades, chemotherapy became incrementally more effective. Different sequences and combinations of drugs yielded marginally better results, and survival rates began to increase. These days, new innovations in immunotherapy and personalized medicine are lifting survival rates further, but cancer still causes so much suffering. Globally, it’s the second leading cause of death, behind only cardiovascular diseases. And while the progress in treatment is real, the disease is extremely complex—it’s not really one disease at all but hundreds of different diseases, or thousands. And it’s also terrifyingly arbitrary. The same chemotherapy regimen may be curative in one patient and not in another, even if they have very similar cancers. The sometimes vicious side effects of chemotherapy—from changes in taste and smell to disabling nausea to infection susceptibility—are experienced differently by different people, often for reasons that are poorly understood. One of methotrexate’s potential side effects, for instance, is that it can cause cancer.

All of this makes cancer and its chemotherapeutic treatment difficult to make sense of in a world that is supposed to make sense. I want things to happen for a reason, a reason I can understand. I want the universe to be fair—or at least to distribute its injustice evenly across the human population. But cancer--like so much else in human life--is radically unfair. We’ve long tried to create causation for cancer where none exists. As Sontag points out in Illness as Metaphor, it was long believed that cancer was caused by repression of emotion, or else by childhood depression. And maybe that’s an easier explanation for healthy people to stomach, because it implies there’s a straightforward reason why you’re healthy while others are sick. They repressed their emotions. Too bad for them.

But in addition to this being complete hogwash, this way of thinking blames the patient for the disease. Sontag writes, “The view of cancer as a disease of the failure of expressiveness condemns the cancer patient: expresses pity but also conveys contempt.” And she knew of what she wrote—while writing Illness as Metaphor, Sontag was in the middle of treatment for breast cancer, including extensive surgery and nearly two years of combinatory chemotherapy that included methotrexate, the drug pioneered by Dr. Jane Wright. A few decades earlier, Sontag’s cancer would’ve almost certainly been fatal. Instead, she lived another thirty years. My grandmother lived for 25 years after her breast cancer diagnosis. She lived to see eight of her grandchildren get married, including me. On the other hand, in 2010, my friend Esther died from cancer at the age of sixteen despite every treatment available at the time. I want the universe to make sense. I want it to be fair. Maybe someday it will be. But not today. Today, at least from where I’m sitting, it seems that the universe is entirely indifferent to our wishes, or else behaves precisely as if it were indifferent.

But we don’t need to be indifferent to one another’s needs and sufferings. So let us pause to give thanks for Sidney Farber and Jane Wright and the many other researchers whose shared efforts have taken us from mustard gas to cancer treatments. But more than that, let us give thanks for all the millions of people who while living with cancer or supporting people living with the disease, have pushed for better treatments. Through advocacy and fundraising and also through working with doctors and nurses to determine the best treatments, those diagnosed with cancer have mapped the convoluted paths toward better treatment.

As Siddhartha Mukherjee wrote in The Emperor of All Maladies, his brilliant book about cancer, “Resilience, inventiveness, and survivorship—qualities often ascribed to great physicians—are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them.”

I give chemotherapy four and a half stars.

Thanks for listening to The Anthropocene Reviewed, which was written by me, edited by Stan Muller, and produced by Rosianna Halse Rojas and Tony Phillips. Joe Plourde is our technical director, and the music is by Hannis Brown. Thanks also to my friend Ryan Sandahl, who suggested I review the hot-dog eating contest while we were watching it this July 4th, and to the anonymous listener who requested a review of chemotherapy. If you’d like to suggest a topic or just say hi, please email us at anthropocenereviewed at gmail dot com. I am biased, of course, but I do feel like our listeners write the best emails in the world. So thank you. If you enjoy the show, I hope you’ll consider rating and/or reviewing it on your podcast app. I am aware of the meta-ness of a show that makes fun of five star reviews asking for five star reviews, but yeah, welcome to the Anthropocene. Thanks again for listening. Last thing, this episode is dedicated to my dad. 35 years and counting, Dad. Thanks for everything.